Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-28T00:04:01.675Z Has data issue: false hasContentIssue false
  • English
  • Français

A double-blind comparison of intrathecal S(+) ketamine and fentanyl combined with bupivacaine 0.5% for Caesarean delivery

Published online by Cambridge University Press:  07 July 2006

H. Unlugenc ,
M. Ozalevli ,
Y. Gunes ,
S. Olguner ,
C. Evrüke ,
D. Ozcengiz  and
H. Akman
H. Unlugenc
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
M. Ozalevli
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
Y. Gunes
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
S. Olguner
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
C. Evrüke
Affiliation:
Cukurova University, Faculty of Medicine, Department of Gynecology and Obstetric, Adana, Turkey
D. Ozcengiz
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
H. Akman
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
Get access

Abstract

Summary

Background: In this prospective, randomized, double-blind, controlled study, we investigated the sensory, motor and analgesic block characteristics of S(+) ketamine, fentanyl and saline given intrathecally (IT) in addition to 0.5% plain bupivacaine (10 mg) for spinal analgesia. Methods: Ninety ASA I or II adult patients undergoing Caesarean section were randomly allocated to receive 1.0 mL of 0.9% saline in Group S (n = 30), 0.05 mg kg−1 of S(+) ketamine (1.0 mL) in Group K (n =30) or 25 μg (1.0 mL) of fentanyl in Group F (n =30) following 10 mg of plain bupivacaine 0.5% IT. We recorded onset and duration of sensory and motor block, time to reach the maximal dermatomal level of sensory block and duration of spinal analgesia. Results: The onset time of sensory and motor block was significantly shorter in Groups K and F than in Group S (P < 0.014). Their duration was significantly longer in Group F than in Groups K and S (P < 0.009). The time to reach the maximal dermatomal level of sensory block was significantly shorter in Groups K and F than in Group S (P < 0.001). The duration of spinal analgesia was significantly longer in Group F than in Groups K and S (P < 0.001). Conclusion: In patients undergoing Caesarean section with spinal analgesia, the addition of S(+) ketamine (0.05 mg kg−1) IT to 10 mg of spinal plain bupivacaine (0.5%) led to rapid onset of both sensory and motor blockade and enhanced the segmental spread of spinal block without prolonging the duration of spinal analgesia, whereas fentanyl provided prolonged analgesia.

Keywords

ANAESTHETICS, INTRAVENOUS, ketamineLOCAL ANAESTHETICS, bupivacaineANALGESICS, OPIOID, fentanylSPINAL ANAESTHESIA
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 12 , December 2006 , pp. 1018 - 1024
Copyright
2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Togal T, Demirbilek S, Koroglu A, Yapici E, Ersoy O. Effects of S(+) ketamine added to bupivacaine for spinal anaesthesia for prostate surgery in elderly patients. Eur J Anaesthesiol 2004; 21: 193–197.Google Scholar
Himmelseher S, Ziegler-Pithamitsis D, Argiriadou Het al. Small-dose S(+)-ketamine reduces postoperative pain when applied with ropivacaine in epidural anesthesia for total knee arthroplasty. Anesth Analg 2001; 92: 1290 –1295.Google Scholar
Calvey TN. Isomerism and anaesthetic drugs. Acta Anaesthesiol Scand 1995; 106 (Suppl): 83–90.Google Scholar
Mathisen LC, Skjelbred P, Skoglund LA, Øye I. Effect of ketamine, an NMDA receptor inhibitor, in acute and chronic orofacial pain. Pain 1995; 61: 215–220.Google Scholar
Arendt-Nielsen L, Nielsen J, Petersen-Felix Set al. Effect of racemic mixture and the (S1)-isomer of ketamine on temporal and spatial summation of pain. Br J Anaesth 1996; 77: 625–631.Google Scholar
Hirota K, Lambert DG. Ketamine: its mechanism(s) of action and unusual clinical uses. Br J Anaesth 1996; 77: 441–444.Google Scholar
Strumper D, Gogarten W, Durieux ME, Hartleb K, Van Aken H, Marcus MA. The effects of S+-ketamine and racemic ketamine on uterine blood flow in chronically instrumented pregnant sheep. Anesth Analg 2004; 98: 497–502.Google Scholar
Kroin JS, McCarthy RJ, Von Roenn N, Schwab B, Tuman KJ, Ivankovich AD. Magnesium sulfate potentiates morphine antinociception at the spinal level. Anesth Analg 2000; 90: 913–917.Google Scholar
Hao JX, Sjolund BH, Wiesenfeld-Hallin Z. Electrophysiological evidence for an antinociceptive effect of ketamine in the rat spinal cord. Acta Anaesthesiol Scand 1998; 42: 435–441.Google Scholar
Ravat F, Dorne R, Baechle JPet al. Epidural ketamine or morphine for postoperative analgesia. Anesthesiology 1987; 66: 819–822.Google Scholar
Wong CS, Liaw WJ, Tung CS, Su YF, Ho ST. Ketamine potentiates analgesic effect of morphine in postoperative epidural pain control. Reg Anesth 1996; 21: 534–541.Google Scholar
Danelli G, Fanelli G, Berti Met al. Spinal ropivacaine or bupivacaine for Cesarean delivery: a prospective, randomized, double-blind comparison. Reg Anesth Pain Med 2004; 29: 221–226.Google Scholar
Klimscha W, Horvath G, Szikszay M, Dobos I, Benedek G. Antinociceptive effect of the S(+)-enantiomer of ketamine on carrageenan hyperalgesia after intrathecal administration in rats. Anesth Analg 1998; 86: 561–565.Google Scholar
Yanli Y, Eren A. The effect of extradural ketamine on onset time and sensory block in extradural anaesthesia with bupivacaine. Anaesthesia 1996; 51: 84–86.Google Scholar
Weir PS, Fee JP. Double-blind comparison of extradural block with three bupivacaine–ketamine mixtures in knee arthroplasty. Br J Anaesth 1998; 80: 299–301.Google Scholar
Chia YY, Liu K, Liu YC, Chang HC, Wong CS. Adding ketamine in a multimodal patient-controlled epidural regimen reduces postoperative pain and analgesic consumption. Anesth Analg 1998; 86: 1245–1249.Google Scholar
Gantenbein M, Abat C, Attolini L, Pisanot P, Emperaire N, Bruguerolle B. Ketamine effects on bupivacaine local anaesthetic activity and pharmacokinetics of bupivacaine in mice. Life Sciences 1997; 61: 2027–2033.Google Scholar
Bion JF. Intrathecal ketamine for war surgery. A preliminary study under field conditions. Anaesthesia 1984; 39: 1023–1028.Google Scholar
Morgan GE, Mikhail MS, Murray MJ. Local anesthetics.Clinical Anesthesiology.The McGraw-Hill Companies, Inc, 2002: 233–240.
Shende D, Cooper GM, Bowden MI. The influence of intrathecal fentanyl on the characteristics of subarachnoid block for Caesarean section. Anaesthesia 1998; 79: 702–710.Google Scholar
Choi DW, Ahn HJ, Kim MH. Bupivacaine-sparing effect of fentanyl in spinal anesthesia for Cesarean delivery. Reg Anesth Pain Med 2000; 25: 240–245.Google Scholar
Sumihisa A, Tomohiro Y, Hiroshi B, Kiichiro T, Satoru F, Koki S. Preemptive analgesia by intravenous low-dose ketamine and epidural morphine in gastrectomy: a randomized double-blind study. Anesthesiology 2000; 92: 1624–1630.Google Scholar
Tomemori N, Komatsu T, Shingu K, Urabe N, Seo N, Mori K. Activation of the supraspinal pain inhibition system by ketamine hydrochloride. Acta Anaesth Scand 1981; 25: 355–359.Google Scholar
Kuusniemi KS, Pihlajamaki KK, Pitkanen MT, Helenius HY, Kirvela OA. The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery. Anesth Analg 2000; 91: 1452–1456.Google Scholar
Palmer CM, Voulgaropoulos D, Alves D. Subarachnoid fentanyl augments lidocaine spinal anesthesia for Cesarean delivery. Region Anesth Pain Med 1995; 20: 389–394.Google Scholar
Sarton E, Teppema LJ, Olievier Cet al. The involvement of the mu-opioid receptor in ketamine-induced respiratory depression and antinociception. Anesth Analg 2001; 93: 1495–1500.Google Scholar
Kathirvel S, Sadhasivam S, Saxena A, Kanan TR, Ganjoo P. Effects of intrathecal ketamine added to bupivacaine for spinal anaesthesia. Anaesthesia 2000; 55: 899–910.Google Scholar
Dhasmana KM, Salt PJ, Faithfull NS, Erdmann W. Effect of intrathecal and intracarotid administration of ketamine on blood pressure and heart rate in rats. Archives Internationales de Pharmacodynamie et de Therapie 1986; 280: 97–105.Google Scholar
Bacigalupo G, Riese S, Rosendahl H, Saling E. Quantitative relationships between pain intensities during labor and beta-endorphin and cortisol concentrations in plasma: decline of the hormone concentrations in the early postpartum period. J Perinat Med 1990; 18: 289–296.Google Scholar